Long-Term Outcomes after Total Pancreatectomy and Islet Cell Autotransplantation: Is it a Durable Operation?
Syed A Ahmad*, Gregory C Wilson*, Jeffrey M Sutton*, Daniel E Abbott*, Jeffrey J Sussman*, Michael J Edwards
Univerisity of Cincinnati, Cincinnati, OH
OBJECTIVE(S): Total pancreatectomy and islet cell autotransplantation (TP/IAT) has been increasingly utilized for the management of chronic pancreatitis (CP) with early success. However, the long-term durability of this operation remains unclear.
METHODS: All patients undergoing TP/IAT for the treatment of CP with five year or greater follow-up were identified for inclusion in this single-center observational study. End points included narcotic requirements, glycemic control, islet function, and quality of life.
RESULTS: From 2002 through 2012, 156 patients underwent TP/IAT. Complete five year follow-up (median 6.2 years, IQR=5.4 - 7.2) was available on 54 patients that underwent total (n=41, 75.9%) or completion (n=13, 24.1%) pancreatectomy with IAT. All patients underwent successful IAT with 6,090 ± 616 islet equivalents per body weight. There was no perioperative mortality and actuarial survival at 5 years was 89%. One year narcotic independence rates were 55% which continued to improve to over 77% at five year follow-up (p<0.05). Insulin independence rates declined over time (38% at one year versus 28% at five years) but insulin requirements (U/d) were similar (21.4 versus 24.3, p=0.6). All patients achieved stable glycemic control with a median hemoglobin A1c of 6.9% (5.85-8.3%). The SF-36 QOL assessment demonstrated continued improvements in all tested modules at 5 year follow-up. Two patients developed diabetic complications requiring whole organ pancreas transplant for salvage.
CONCLUSIONS: This represents the largest series examining long-term outcomes after TP/IAT. TP/IAT produces durable pain relief and improvement in QOL parameters. Insulin independence rates decline over time, however patients maintain glycemic control.
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